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  • Title: A rare case of group A streptococcal endocarditis with absence of valvular vegetation.
    Author: Branch J, Suganami Y, Kitagawa I, Stein GH, Tanaka E.
    Journal: Intern Med; 2010; 49(15):1657-61. PubMed ID: 20686310.
    Abstract:
    Group A streptococcal endocarditis has been described in intravenous drug misusers and as a post-varicella infection in children. We report a 64-year-old man with no prior risk factors who presented with a persistent fever, malaise, polyuria and cola-colored urine. On examination peripheral stigmata of endocarditis without a cardiac murmur and asymptomatic pharyngeal exudates were found. Blood and urine analysis revealed renal failure from suspected glomerulonephritis. Blood cultures revealed fully sensitive Group A streptococci. Transthoracic and transesophageal echocardiographies revealed no vegetation. The Modified Duke's Criteria aided in the diagnosis of definite infective endocarditis, despite the absence of valvular vegetation.
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